Don’t break a leg!

Maryland Family, August 2004

Kids will be kids, right? Parents who are lucky enough to get their kids away from television and video games and get outside for some exercise will occasionally have a scratch, bump or bruise to bandage up, but that’s just part of being a parent. But what happens when bumps turn into breaks, and the breaks start happening more and more often?

According to a recent study by the Mayo Clinic, forearm fractures are on the rise in both adolescent boys and girls. The study compared the number of forearm fractures in young people in Rochester, Minnesota from 1969-1971 to the number of forearm fractures for the same population from 1999-2001 and found that the rate of forearm fractures skyrocketed by 42 percent (262 per 100,000 people annually in 1969-1971, to 373 per 100,000 in 1999-2001). During the most recent time period, girls between ages 8 and 11 and boys between ages 11 and 14 had higher fracture rates than all other groups studied; 12-year-old boys had the highest rate of all — 1,536 per 100,000 people, or 1.5 percent per year.

The study, published last fall in the Journal of the American Medical Association, points out that typically the incidence of distal forearm fractures (those located near the wrist) peaks around age 12 in girls and 14 in boys during kids’ growth spurts. The study was unable to draw any conclusions as to why these fracture rates have increased but did raise concerns over children’s dietary habits — specifically increased soft drink consumption and decreased milk consumption — and changing patterns of physical activity.

“We have definitely seen an increase in the number of fractures sustained by our patients,” says Robert Baldwin, M.D., of Parnes, May and Associates, a pediatric practice in Ellicott City. Dr. Baldwin points to several factors for the rising rate of forearm fractures, most of them surrounding physical activity. “The most important factor is increased participation in the ‘X-Game’ sports such as skateboarding, rollerblading, street luging, BMX bikes and snowboarding. We are also seeing athletes participating in highly-competitive team sports such as ‘travel’ baseball and soccer at younger ages before their bodies and skills have matured, resulting in more accidental and overuse injuries.”

Dr. Baldwin also points to a number of injuries resulting from accidents on playground equipment. “There is also a growing number of injuries occurring at home associated with the proliferation of large backyard playgrounds. Most of these have open platforms that are more than six feet off the ground, and the playground itself is situated on the lawn rather than the recommended soft play surface,” he says.

Dan Hoernschemeyer, M.D., of Johns Hopkins Pediatric Orthopedics agrees that changing physical activity habits in children is a major factor. “The biggest impact on the number of injuries with kids is the pattern of physical activity,” he says. “Kids now are more likely to rollerblade or skateboard than other sports. Also, snowboarding has seen a big increase over the past few years. Last year we saw a lot of injuries due to non-motorized scooters and dirt bikes. Kids fall off them a lot, which leads to open forearm fractures.” Dr. Hoernschemeyer says that distal radius fractures are the most common in adolescents and that upper extremity injuries are more common than lower extremity ones. Both Dr. Hoernschemeyer and Dr. Baldwin note that summer still results in the highest number of fractures of all seasons.

The growing increase in sports participation by girls is another factor to consider when studying the rising rate of forearm fractures, says Dr. Hoernschemeyer. “The competition in female sports has increased dramatically,” he says. One of Dr. Hoernschemeyer’s most recent patients, an 11-year-old girl, just broke her arm for the second time in a year. Megan Alley, who broke her arm last year when it was stepped on during a soccer game, broke her arm again this summer while rollerblading.

“When I was a girl, I twirled the baton and jumped rope,” laughs Megan’s mom, Wendy Alley of Catonsville. “Girls today are more sports-oriented and play more lacrosse, soccer and basketball.” Alley says that she believes Megan’s small size is a major factor for her injuries. “She’s only 65 pounds. Compared to the other girls going into the seventh grade, she’s tiny. Last year, when she broke her arm, it was simply the result of a larger girl stepping on her arm after she fell.”

In addition to increased physical activity, the Mayo Clinic report also raised questions on whether children are receiving enough calcium in their diets or are they drinking too many sodas. On this matter, experts in the medical community agree that more studies must be done.

“The role of poor calcium intake as a causative factor for increasing fractures is difficult to quantify,” says Dr. Baldwin. “It’s too early in the research stage to draw any conclusions on calcium intake and make recommendations to parents,” adds Dr. Hoernschemeyer, “but [calcium intake] is something that needs to be looked at further.”

“The increased number of fractures in children may be a result of poor nutrition, but that is something that needs to be studied further,” says Timothy Doran, M.D., chairman of pediatric medicine at the Greater Baltimore Medical Center (GBMC). “However, one thing that is crystal clear is that the consumption of sodas has increased over the past few years. The Mayo Clinic study is definitely an alert; any research that we can use to look at the dietary habits of children is great. Many kids’ dietary habits are inadequate.” Dr. Doran points to this year’s movie, “Super Size Me,” an independent movie that examined America’s fascination with fast food and the growing number of Americans who are obese.

“That movie was great,” says Dr. Doran. “I do a lecture called, ‘Don’t Clean Your Plate,’ so that movie resonated with me. My son just went to Europe and noticed that the average soda size in a restaurant was seven ounces, not 16 or 20 like here.”

Dr. Hoernschemeyer agrees. “There’s lots of literature from Europe that cites that younger kids’ diets are more deficient than before, and the increase of carbonated beverage consumption and the decrease of milk consumption are seen as factors. I’ve also read in the last year that the number of kids drinking milk has decreased by 15 percent, while soda consumption increased by 15 percent.”

Only about half of children aged 5 years and under get enough calcium in their diets, and more than 85 percent of all girls ages 12 to 19 do not get the recommended amount of calcium, according to the National Institutes of Health’s National Institute of Child Health & Human Development (NICHD). The Institute notes that calcium intake is especially important during childhood and teen years because bones are growing fast and need calcium to be strong.

“Milk obviously is very important,” says Alley. “My daughter eats two bowl of Cheerios every day and always finishes the milk. I also put water in her lunch bag instead of soda.”

Until further research is done to determine conclusive reasons why kids are breaking more bones, Dr. Doran recommends the old adage, “safety first.”

“The most important advice to kids and their parents is to use the recommended safety gear such as wrist guards and knee pads in addition to helmets. I also advise parents to be actively involved in their child's sport and try to keep your 12-year-old from jumping his or her skateboard over cars or down handrails.”

For more information on the importance of calcium and for useful tips on ways to increase your child’s calcium intake, check out the “Milk Matters” campaign on the NICHD’s Web site, www.nichd.nih.gov/milk.